Hypnosis Treated an Inability to Burp

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Some patients develop an inability to burp (abelchia) because the muscle that surrounds the bottom of the throat (the cricopharyngeus muscle) remains overly tight when they attempt to allow air to pass upwards through their food pipe.

This has been recently termed “retrograde cricopharyngeal dysfunction. (R-CPD)” (Karagama, 2021). This disorder can cause people to develop uncomfortable distension of their stomach after meals.

Studies have demonstrated that a single dose of botulinum toxin A (Botox) injected into the cricopharyngeus muscle under general anesthesia helps resolve this condition in most patients. Botox is thought to work by temporarily paralyzing the muscle (Hoesli, 2020).

I recently wrote about a 19-year-old patient who complained of an inability to burp his entire life (Anbar & Spence, 2023). This caused him to feel discomfort after large meals. The patient had heard about Botox therapy for his condition and was considering undergoing this procedure.

This patient had previously demonstrated great success in using hypnosis for the treatment of his anxiety and insomnia. I proposed to him that improvement of his abelchia could be accomplished through the use of hypnosis as well, rather than the administration of Botox. I speculated that hypnosis could be beneficial in this setting because it can affect muscle function. For instance, using imagery can help people lift weights better (Slimani, 2016).

Initially, the patient tried to relax his crycopharyngeus muscle by asking his subconscious to help, but this did not help him burp. The patient then volunteered that when he tries to burp, he begins to gag, and he worried that he might throw up.

I suggested he imagine applying a numbing cream to his throat when he tries to burp so that his gag reflux would not be elicited. The patient reported that the application of the imagined cream reduced his propensity to gag, but he still could not burp.

Finally, I suggested that the patient ask his subconscious to relax his cricopharyngeus muscle at the same time that he numbed his gag reflex. This allowed the patient to burp small amounts of air. The total time of treatment for the abelchia was a month.

I recommended that the patient continue to practice the latter techniques with the suggestion that as a mind/body skill, hypnosis application improves with practice. Indeed, after half a year, he reported no difficulty with burping large amounts of air loudly.

Lessons Learned

As R-CPD resolves with hypnosis, it is likely that R-CPD represents a functional disorder that can resolve with a psychological approach. Functional disorders should be suspected when: (1) Symptoms present without an identifiable physical cause, (2) The intensity of symptoms exceeds what is expected based on their physical cause, and/or (3) Symptoms fail to respond as expected to medical treatment (Anbar & Spence, 2023).

In the case of R-CPD, I suspected a functional disorder because the symptoms resolved after a single dose of Botox, which wears off after three months. Thus, the symptoms responded much more than expected to medical treatment. If the problem were primarily physical, it would be expected that the symptoms would have recurred after the Botox wore off.

Keep in mind that similar symptoms can have physical or functional origins. For example, shortness of breath can develop due to asthma (a physical cause) or anxiety (a functional cause). It can be especially difficult to properly diagnose patients whose symptoms persist because of a combination of physical and functional factors (such as patients with asthma and anxiety).

Hypnosis can help resolve other functional symptoms in the head and neck, such as vocal cord dysfunction (Anbar & Fernandes, 2016). In my experience, it also has helped with cervical dystonia, bruxism, and rhinitis. Hypnosis has been shown to resolve functional disorders in many other parts of the body, such as migraine headaches, shortness of breath, irritable bowel syndrome, and some tremors.

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When a person develops a functional disorder, the symptoms serve a function, although sometimes the function is not obvious. The patient described in this blog may have developed his inability to burp in order to protect him from gagging. Thus, his symptoms only improved after I taught him to hypnotically suppress his gag reflex.

Takeaway

Successful hypnosis therapy must involve addressing the underlying cause(s) of symptoms. In this case, the therapy addressed both relaxing the muscle and the fear of gagging. A nonspecific approach, such as asking the subconscious to solve the issue, was ineffective.

Since functional disorders often resolve with the use of hypnosis or other psychological therapies, it is best medical practice to offer such non-invasive therapies for functional disorders before the use of medications, including botulinum toxin, which are more costly and carry a greater risk of complications.

Portions of this blog were first published in the American Journal of Clinical Hypnosis (Anbar & Spence, 2023).